Sign Out
Symptoms and signs: The following symptoms were observed: fall of blood pressure ≤90 mmHg, pallor, sweating, weak pulse, tachycardia, postural dizziness, headache, asthenia, dizziness, nausea, vomiting, diarrhoea.
Methaemoglobinaemia has been reported in patients receiving other organic nitrates. During isosorbide dinitrate biotransformation nitrite ions are released, which may induce methaemoglobinaemia and cyanosis with subsequent tachypnoea, anxiety, loss of consciousness and cardiac arrest. It cannot be excluded that an overdose of isosorbide dinitrate may cause this adverse reaction.
In very high doses the intracranial pressure may be increased. This might lead to cerebral symptoms.
Treatment: General procedure: stop delivery of the drug.
General procedures in the event of nitrate-related hypotension: the patient must be laid down with lowered head and raised legs; supply oxygen, expand plasma volume (i.v. fluids), specific shock treatment (admit patient to intensive care unit).
Special procedure: raise the blood pressure if the blood pressure is very low; vasopressors should be used only in patients who do not respond to adequate fluid resuscitation.
Treatment of methaemoglobinaemia: reduction therapy of choice with vitamin C, methylene-blue, or toluidine-blue; administer oxygen (if necessary); initiate artificial ventilation.
Resuscitation measures: in case of signs of respiratory and circulatory arrest, initiate resuscitation measures immediately.
Further management should be as clinically indicated or as recommended by the national poisons centre, where available.
